Expression of Plasmodium falciparum genes involved in erythrocyte invasion varies among isolates cultured directly from patients

Plasmodium falciparum merozoites invade erythrocytes using a range of alternative ligands that includes erythrocyte binding antigenic proteins (EBAs) and reticulocyte binding protein homologues (Rh). Variation in the expression of some of these genes among culture-adapted parasite lines correlates with the use of different erythrocyte receptors. Here, expression profiles of four Rh genes and eba175 are analysed in a sample of 42 isolates cultured from malaria patients in Kenya. The profiles cluster into distinct groups, largely because of very strong negative correlations between the levels of expression of particular gene pairs (Rh1 versus Rh2b, eba175 versus Rh2b, and eba175 versus Rh4), previously associated with alternative invasion pathways in culture-adapted parasite lines. High levels of eba175 are seen in isolates in expression profile group I, and may be associated with sialic acid-dependent invasion. Groups II and III are, respectively, characterized by high levels of Rh2b and Rh4, and are more likely to be associated with sialic acid-independent invasion.     

Quality of life in glaucoma patients: regression analysis and correlation with possible modifiers

PURPOSE: To verify the quality of life in a Brazilian glaucoma population and the influence of possible modifiers (e.g., visual acuity, visual field impairment). METHODS: Forty-five consecutive patients from CEROF - Federal University of Goias, Brazil were included prospectively in the study. The quality of life was assessed using the Portuguese version of the VFQ. Possible modifiers were evaluated, initially separately with the Spearman's Correlation and then together in a regression model. RESULTS: The mean age was 59.6 +/- 12.4 years. The mean quality of life score was 79 +/- 15 (range 45-100). Age (r = -0.402, p = 0.006), visual acuity in the better eye (r = -0.497, p = 0.001) and in the worse eye (r = -0.608, p < 0.001), Hodapp-Parrish-Anderson visual field grading scale in the better (r = -0.353, p = 0.01) and worse eye (r = -0.387, p = 0.009), visual field Mean Deviation (MD) in the better (r = 0.355, p = 0.01) and worse eye (r = 0.320, p = 0.04) and ability to perform a visual field test in both eyes (r = -0.397, p = 0.007) were significantly correlated with the quality of life scores. However, only age (younger, better quality of life, p = 0.008) and visual acuity in the better eye (direct relation, p = 0.04) were significant in the regression model (r = 0.633, r(2) = 0.401). CONCLUSIONS: The VFQ may be a useful tool to assess the quality of life in glaucoma patients. The preliminary results indicate that age and visual acuity in the better eye are the main factors related to the quality of life in these patients.     

The effect of memory stimulation practices as a therapeutic method on healthy elders

Considering the constant complaints of the elderly regarding their memory performance, this study aims to investigate the effect of memory stimulation on the performance in the Mini Mental State Examination (MMSE) and to observe the socio-demographic correlation with cognitive performance. The MMSE was applied in 46 elders without dementia diagnosis that participated in a memory workshop before and after the activities of the workshop were carried out. Correlation and statistical significance was observed between the MMSE's scores applied before and after the workshop, but there were no statistically significant association between this performance and the socio-demographic variables.     

Successful treatment of posttransplant lymphoproliferative disease with prolonged rituximab treatment in intestinal transplant recipients

BACKGROUND: Posttransplant Epstein-Barr virus-associated B-cell lymphoproliferative disease (PTLD) has a higher incidence after intestinal transplantation than after transplantation of other solid organs and is associated with a high mortality. A new anti-CD20 monoclonal antibody, rituximab, has shown efficiency in the treatment of B-cell lymphoma, including PTLD, but its use has not yet been reported in intestinal transplant recipients. METHODS: We retrospectively reviewed five patients who were diagnosed with PTLD from March 1999 to August 2001, after intestinal transplantation. These patients were primarily managed with rituximab, associated with reduction or interruption of immunosuppression and antiviral therapy with ganciclovir and cytomegalovirus immune globulin. Rituximab was administered at weekly doses of 375 mg/m until full remission was ascertained, and the interval between doses was then increased. No patient received chemotherapy. RESULTS: One patient had nonmalignant lymphoproliferation, and four had malignant PTLD, as assessed by histopathology and monoclonality of the tumor. Two pediatric patients had severe generalized disease. All patients had received OKT3 as treatment of rejection before developing PTLD. All tumors showed proliferation of CD20 cells and were positive for Epstein-Barr virus by in situ hybridization. All patients responded to rituximab therapy and have achieved full remission with a follow-up of 3 to 30 (median, 8) months. CONCLUSION: Prolonged rituximab treatment, in association with reduction of immunosuppression and antiviral therapy, is highly efficient as part of the first-line treatment of CD20 B-cell PTLD after intestinal transplantation.     

Transplantation of islets of Langerhans in patients with insulin-requiring diabetes mellitus undergoing orthotopic liver transplantation – the Miami experience

Most patients with cirrhosis of the liver have detectable insulin resistance. In 60–80% of patients with cirrhosis, impaired glucose tolerance can be uncovered; approximately 20% of these patients eventually develop overt diabetes. Theoretically, insulin resistance and glucose intolerance could be improved or reversed by orthotopic liver transplantation alone or in association with a simultaneous transplant of pancreatic islet cells from the same donor. To investigate these possibilities we initiated a pilot study of simultaneous liver and pancreatic islet cell transplantation in seven patients with diabetes and liver cirrhosis. Donor bone marrow cells were also infused to enhance the acceptance of the grafts. Seven patients who received only orthotopic liver transplantation and donor bone marrow cells were used as historical controls. The preliminary results of this pilot trial suggest that islet cell transplantation in conjunction with orthotopic liver transplantation improves glucose metabolism in patients with liver cirrhosis in association with reduced insulin requirements and HbA1c levels. These results were evident in spite of pre- and post-transplant basal C-peptide levels that were unchanged. Further evaluation of the effects of orthotopic liver transplantation with or without islet cell transplantation will require a randomized prospective trial including accurate metabolic evaluation with the euglycemic insulin clamp technique.